digestive issues

The Complex Ways Eating Disorders and Digestive Disorders Intersect

April 22, 2025 Digestive Disorders

Many ED Clinicians never think that if they are working with ED clients, they are also working with Digestive Disorders.

For the past 8 years I have been learning, educating, and speaking out about the complex ways eating disorders (EDs) and digestive disorders intersect.

Which is why I was particularly thrilled to learn that The Consortium for Research in Eating Disorders (CoRe-ED) is teaming up with Monash FODMAP for a special social media campaign to highlight the particular relationship between Irritable Bowel Syndrome (IBS) and EDs. The campaign runs from April 21-27, so if you’re on social media be sure to follow along (I’ll provide all the links at the end of this article).

Why should you care about IBS and EDs?

  • If you’re an ED clinician, you are DEFINITELY working with clients who have it. Prevalence rates of Disorders of Gut-Brain Interaction (DGBIs), are as high as 95.5% in ED populations, with IBS being one of the most common (Wiklund 2021).
  • Research consistently shows an increased risk of disordered eating behaviors (18%) in individuals with IBS and clinically significant EDs (12.8%) (Sultan 2024;Ordaz-Alvarez 2024).

Listed below is a fast and furious summary of what IBS is, describe the interplay between both conditions, and offer some basic tips for management. Then we’ll wrap up with some suggestions for further learning.

work with Eds work with digestive issues

What is IBS, really?

Ok, if we’re being honest, IBS is a sneaky pain in the a** (pun intended). It’s a collection of burdensome symptoms like pain, bloating, constipation and/or diarrhea. It occurs in genetically vulnerable individuals when the head brain and gut brain need to go to couples therapy. Our nervous system runs from our head to our gut. And our nervous system and the microbiome living in our gut play major roles in how it functions. Communication breakdowns are a very simple way of understanding why IBS sufferers experience a wide range of GI symptoms. It also explains why treatment for IBS requires many different tools (more on this later).

Unlike other gastrointestinal conditions (like celiac disease) where there is visible damage to the GI tract, there is nothing visible wrong with the GI system in those with IBS. One challenging aspect of IBS is that it’s a diagnosis of exclusion. So basically, individuals have to eliminate all other sources of their symptoms before getting an official diagnosis. That often leaves people feeling worn out and gaslit – they know they have horrible symptoms yet every GI test comes up negative.

Dynamic interplay between IBS and EDs

The complex relationship between these two conditions is still getting fleshed out. But we do know a few things (Atkins 2023; Burton Murray 2022):

  • Both conditions share temperamental and mental health risk factors like anxiety, perfectionism and rigidity.
  • GI pain makes eating very difficult and uncomfortable. Naturally, people to turn food as the thing to “fix” to help our bellies feel better. This can unintentionally become a rabbit hole for those most vulnerable. Restriction can offer short-term relief but can create massive problems if utilized as the sole way to manage IBS.
  • Underlying malnutrition, whether from an ED or a GI condition, literally creates IBS symptoms. Correcting malnutrition is essential to decreasing IBS symptoms.

Tips for Managing IBS in Individuals with EDs (Staller 2023)

  • Aim for as liberal of a diet as possible. Food modification (timing, texture, balance, consistency) rather than food elimination should be prioritized. Basic nutrition pillars which support ED recovery (balanced meals and snacks at regular intervals, reduce diet foods and beverages) also support IBS.
  • Utilize and prioritize non-food tools and strategies. While food modifications may be imperative and incredibly helpful, bear in mind IBS stems nervous system disorganization.  Relying on food-only strategies is a massive disservice and discouraged for people with EDs in particular. I offer 23 suggestions in this ​free resource​ but will give a particular shout out here for: – Nervous system regulation supports: diaphragmatic breathing, gut directed hypnotherapy ​(Nerva app)​, gentle yoga and walking, reiki, heating pads, aromatherapy, warm baths, journaling, self-compassion practice
    • Pelvic floor physical therapy
    • Medication

Whether you are an individual or a clinician, there are some incredible resources available to you to support your ongoing learning on this topic.

For Clinicians

For Anyone (these are not ED-specific but I do think that they are relatively ED-sensitive)

Finally, if you want to follow along the ​CoRe-ED​ IBS and ED campaign, check out these links:

If you have and/or are treating individuals who have BOTH an ED and IBS, what have you found to be particularly effective? I’d love to know your thoughts!

This is such a tough intersection to live in and work with. I’m rooting for you and sending you my very best.

marci evans RD boston MA

 

 

 

 

Citations:

  • Atkins, M., Burton Murray, H., & Staller, K. (2023a). Assessment and management of disorders of gut–brain interaction in patients with eating disorders. Journal of Eating Disorders, 11(1). ​https://doi.org/10.1186/s40337-022-00731-6​
  • Burton Murray, H., & Staller, K. (2022). When Food Moves From Friend to Foe: Why Avoidant/Restrictive Food Intake Matters in Irritable Bowel Syndrome. Clinical Gastroenterology and Hepatology, 20(6). ​https://doi.org/10.1016/j.cgh.2021.09.017​
  • Ordaz-Alvarez HR, Priego-Parra BA, Reyes-Diaz SA, Garcia-Zermeño KR, Del Rocio Francisco M, Amieva-Balmori M, Lemus-Chavarria MP, Roesch-Ramos L, Cano-Contreras AD, Roesch-Dietlen FB, Remes-Troche JM. Prevalence of Eating Disorders Among Adults With Irritable Bowel Syndrome: A Cross-Sectional Study. J Clin Gastroenterol. 2024 Nov 12. doi: 10.1097/MCG.0000000000002101. Epub ahead of print. PMID: 39918257.
  • Staller, K., Abber, S. R., & Burton Murray, H. (2023). The intersection between eating disorders and gastrointestinal disorders: a narrative review and practical guide. The Lancet Gastroenterology & Hepatology, 8(6). ​https://doi.org/10.1016/S2468-1253(22)00351-X​
  • Sultan N, Foyster M, Tonkovic M, Noon D, Burton-Murray H, Biesiekierski JR, Tuck CJ. Presence and characteristics of disordered eating and orthorexia in irritable bowel syndrome. Neurogastroenterol Motil. 2024 Jul;36(7):e14797. doi: 10.1111/nmo.14797. Epub 2024 Apr 12. PMID: 38606723.
  • Wiklund, C. A., Rania, M., Kuja‐Halkola, R., Thornton, L. M., & Bulik, C. M. (2021). Evaluating disorders of gut‐brain interaction in eating disorders. International Journal of Eating Disorders, 54(6), 925–935. ​https://doi.org/10.1002/eat.23527